Balancing Bureaucracy and Patient Care as a Physician

June 11, 2012

We need patients to understand that while physicians don't always agree with the rules, we can't just skirt around them.

A few months ago I received a letter form CMS letting me know that I am an “over utilizer” of diabetes testing supplies. I'm told compared to other physicians in the country and in the state in which I practice, I order a higher volume of diabetes testing supplies than my peers. Well, maybe that’s because I am an endocrinologist. Makes sense to me.

And I’m sure many of you have received forms from diabetes supply companies asking you to document how often patients actually test and to provide records to justify frequent testing. Now, of course, “frequent” is a relative term. I think that if someone is taking four insulin injections a day, testing four times a day is not too frequent, but Medicare disagrees. Any more than three times a day requires documentation and a reason for frequent testing. Anyone on oral agents, according to CMS guidelines, should only be testing once a day.

Now, I certainly have patients that I am hard pressed to get to test at all. On the other hand, I have highly motivated patients who want to test twice a day even if they are well-controlled on oral agents, or four times to five times a day when they are on insulin. And not that I disagree with them, but I do have to abide by the rules.

I had a patient two weeks ago ask me to write her prescription for testing supplies for two times a day instead of once a day. I said she only checks once a day. She said she checks twice. Well, we had downloaded the memory from her meter, and guess what - some days she checks once, some days not at all. While I would love for her to test more frequently, I am the one being scrutinized by the powers-that-be, and I could not and would not write a false prescription to save her a few dollars.

On a slightly different note, last week, I had a gentleman ask me to write a prescription saying he takes 100 units of insulin a day, instead of the 80 units he actually takes so that he can get a few extra insulin pens for the same copay. I came right out and told him that I will not commit Medicare fraud for him.

Physicians are under scrutiny, and it has become our task to curtail healthcare costs. Sometimes the rules seem arbitrary and not clinically based, but we also need patients to understand, that while we don’t always agree with the rules, we can’t just skirt around them.

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